MEDICARE: REBECCA JAHN CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	243696	NC
2	367500000X	Certified Registered Nurse Anesthetist	4704154430	MI
3	367500000X	Certified Registered Nurse Anesthetist	APRN.CRNA.0020327	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	430F364420	OTHER	MI	BCBSM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134197536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA JAHN CRNA

Provider Business Mailing Address
First Line	:	4100 PARK FOREST DR
Second Line	:	SUITE 210
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684
Country	:	US
Telephone Number	:	231-935-5770
Fax Number	:	231-935-0747

Provider Business Practice Location Address
First Line	:	4100 PARK FOREST DR STE 210
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-7306
Country	:	US
Telephone Number	:	231-935-5770
Fax Number	:	231-935-0747

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	09/01/2021

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Directions to “ REBECCA JAHN CRNA” Practice Location

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